膝骨性关节炎MRI成像和关节镜检查的比较

1、膝骨性关节炎MRI成像和关节镜检查的比较         11-02-09 11:16:00     作者：高益，瞿玉兴，沈鹏飞    编辑：studa20【摘要】  目的：通过对膝骨性关节炎(OA)关节软骨病损MRI成像和关节镜检查结果的对照比较,研究两者对反映膝关节软骨病损的严重程度是否具有相关性,以指导临床医师如何对膝OA关节软骨病损进行科学有效的评估及制定相应的治疗方案。方法：将每个膝关节的软骨面分成6个部分: 股骨内

2、髁面、股骨外髁面、髌骨内侧面、髌骨外侧面、胫骨平台内侧面和胫骨平台外侧面。术前由磁共振医师按Recht分级标准对各序列图像中关节软骨情况作出诊断和病变分级, 写出报告。关节镜检查术前参考常规序列的MRI片, 术中采集关节镜检图片, 以术中关节镜下所见和采集的图片对病变进行评价并写出报告。结果：40例膝关节共240个关节面, MRI和(或)关节镜发现有软骨病变的关节面共101处, 以关节镜的诊断为标准，评价各级MRI诊断的准确性，灵敏性，特异性，一致性。其中1级诊断分析：灵敏度=58.62%，特异度=86.11%，ROC曲线下面积为0.852，与机会线0.5相比，差异有统计学意义(P<0.

3、0001);2级诊断分析：灵敏度=86.96%，特异度=85.90%，ROC曲线下面积为0.870，与机会线0.5相比，差异有统计学意义(P<0.0001);3级诊断分析：灵敏度=86.36%，特异度=96.20%，ROC曲线下面积为0.875，与机会线0.5相比，差异有统计学意义(P<0.0001);4级的诊断分析：灵敏度=94.44%，特异度=97.59%，ROC曲线下面积为0.940，与机会线0.5相比，差异有统计学意义(P<0.0001)。结论：软骨病损的程度越严重，MRI可以比关节镜更早一步发现软骨早期病变。 【关键词】  膝骨性关节炎;软骨损伤;MRI;

4、关节镜ABSTRACT Objective: To compare the difference between MRI image and arthroscopy, and research the relationship of two methods to the serious degree of knee joint cartilage disease. Methods: Each surface of knee cartilage was divided into 6 parts: Surface of epicondylus medialis femoris, surface o

5、f epicondylus lateralis femoris, facies medialis of patella, facies lateralis of patella, facies medialis of tibial plateau, facies lateralis of tibial plateau. The doctor of performing the MRI made the diagnosis and the pathologic classification on the basis of Recht's grading standard by MRI i

6、mage before operation. The doctor of performing arthroscopy made the classification by both the finding of arthroscopy and the image which were collected by arthroscopy. Results: Total 240 joint surfaces of 40 knee joints. The arthroscopy and (or) MRI discovered 101 cartilage pathological changes of

7、 different degree. Taking the diagnosis of the arthroscopy as standard, all the levels of MRI diagnosis of accuracy, sensibility, specificity and consistency were evaluated. The class 1: sensibility=58.62%，specificity=86.11%, the acreage below ROC curves was 0.852.Comparing to the opportunity line 0

8、.5，the difference was statistical significance(P<0.000 1). The class 2: sensibility=86.96%，specificity=85.90%, the acreage below ROC curves was 0.870. Comparing to the opportunity line 0.5，the difference was a statistical significance (P<0.000 1). The class 3: sensibility=86.36%，specificity=96

9、.20%, the acreage below ROC curves was 0.875. Comparing to the opportunity line 0.5，the difference was a statistical significance (P<0.000 1).The class 4: sensibility=94.44%，specificity=97.59%, the acreage below ROC curves was 0.940. Comparing to the opportunity line 0.5，the difference was a stat

10、istical significance(P<0.000 1). Conclusion: The cartilage disease more serious, the MRI diagnosis is more valuable. Moreover, before appearance of the joint cartilage injury, MRI can discover cartilage earlier period pathological changes, earlier than using arthroscopy.KEY WORDSKnee OA; Cartilag

11、e hurts; MRI; Arthroscopy骨性关节炎(OA)指由各种因素引起的关节软骨纤维化、开裂、缺损、脱失而导致的关节疾病。病因目前尚不确切，其发生可能与年龄、肥胖、炎症、创伤及遗传因素等有关，其病理特点为关节软骨变性破坏缺损、软骨下骨硬化或囊性变、关节边缘骨质增生、滑膜增生、关节囊挛缩、韧带松弛或挛缩、肌肉萎缩无力等。OA以中老年患者多见，男性少于女性。60岁以上的人群中患病率可达50%，75岁的人群则达80%，该病的致残率可高达53%。OA好发于负重大、活动多的关节，如膝、脊柱(颈椎和腰椎)、髋、踝、手等关节。目前，该病的诊断主要还是依靠症状、体征和影象学改变，尚缺乏特异性和敏

12、感性俱佳的诊断方法。MRI和关节镜为医生诊断和治疗OA提供了极大的帮助1，但对MRI和关节镜诊断OA的比较研究相对较少。故我们将其分级对比，以期能找到更为准确实用的诊断方法。1 资料与方法1.1 病例来源高益等.膝骨性关节炎MRI成像和关节镜检查的比较选取常州市中医院骨伤科2009年5月2010年3月行膝关节镜和MRI检查的膝OA患者40例，其中男性15例，女性25例，年龄4183岁，平均56.8岁。1.2 关节镜下软骨损伤程度分级标准按Outerbridge标准分级2：0级：正常关节软骨;级：软骨变软或局部肿胀;级：软骨表面纤维化轻，软骨缺损厚度小于50%;级：软骨表面纤维化重，龟裂明显，软

13、骨缺损厚度大于50%，尚未暴露软骨下骨;级：软骨完全缺损，软骨下骨外露。1.3 MRI软骨损伤相对应的分级标准MRI分级按照Recht标准3：0级：正常关节软骨，软骨弥漫性均匀变薄但表面光滑，仍认为是正常关节软骨;级：软骨分层结构消失，软骨内出现局限性低信号区，软骨表面光滑;级：软骨表面轮廓轻至中度不规则，软骨缺损深度未及全层厚度的50%;级：软骨表面轮廓重度不规则，软骨缺损深达全层厚度的50%以上，未见完全剥脱;级：软骨全层剥脱、缺损，软骨下骨暴露伴或不伴软骨下骨质信号改变。1.4 方法将每个膝关节的软骨面分成6个部分: 股骨内髁面、股骨外髁面、髌骨内侧面、髌骨外侧面、胫骨平台内侧面和胫骨平台外侧面。术前由磁共振医师按Recht分级标准综合各序列图像中关节软骨情况作出诊断和病变分级, 写出报告。关节镜检查术前参考常规序列的MRI片, 术中采集相对应的关节镜图片, 以术中关节镜下所见和采集的图片对病变进行评价并写出报告。对照这两份报告, 汇总数据。1.5 统计学处理采用SPSS11.5软件进行统计学处理。以关节镜下诊断作为标准,各MRI分级诊断的灵敏度和特异度的比较采用2检验